caa a22 4500 44533570X CHVBK 20180317142754.0 cr unu---uuuuu 170323e20111001xx s 000 0 eng 10.1245/s10434-011-1689-0 doi (NATIONALLICENCE)springer-10.1245/s10434-011-1689-0 Selective Sentinel Lymph Node Dissection for Melanoma: Importance of Harvesting Nodes with Lower Radioactive Counts without the Need for Blue Dye [Elektronische Daten] [Liang-Chih Liu, Brian Parrett, Tyler Jenkins, Wayne Lee, Eugene Morita, Patrick Treseler, Laura Huang, Suresh Thummala, Robert Allen, Mohammed Kashani-Sabet, Stanley Leong] Background: Determining how many sentinel lymph nodes (SLNs) should be removed for melanoma is important. The purpose of this study is to determine the frequency at which nodes that are less radioactive than the "hottest” node (which is negative) are positive for melanoma, how low of a radioactivity should warrant harvest, and if isosulfan blue is necessary. Methods: We reviewed 1,152 melanoma patients who underwent lymphoscintigraphy with technetium, with or without blue dye, and SLN dissection from 1996 to 2008. SLNs with radioactivity ≥10% of the "hottest” SLN, all blue nodes, and all suspicious nodes were removed and analyzed. The miss rate was calculated as the proportion of node positive cases in which the "hottest” SLN was negative. Results: SLNs were identified in 1,520 nodal basins in 1,152 patients. SLN micrometastases were detected in 218 basins (14%) in 204 patients (18%). In 16% of SLN-positive patients (33/204 patients), the positive SLN was found to have a lower radioactive count than the "hottest” SLN, which was negative. In 21 of these cases, the positive SLNs had radioactivity ≤50% of the "hottest” SLN. The 10% rule significantly reduced the miss rate to 2.5% compared with removal of only the "hottest” SLN (miss rate=16%). Also, blue dye did not significantly decrease the miss rate compared with radiocolloid alone using the 10% rule. Conclusions: To decrease the miss rate, all SLNs with ≥10% of the ex vivo radioactivity of the "hottest” SLN should be removed and blue dye is not essential. Society of Surgical Oncology, 2011 Liu Liang-Chih Department of Surgery, University of California, San Francisco, CA, USA aut Parrett Brian The Buncke Clinic, Division of Plastic Surgery, California Pacific Medical Center, San Francisco, CA, USA aut Jenkins Tyler Department of Surgery, University of California, San Francisco, CA, USA aut Lee Wayne Department of Surgery, University of California, San Francisco, CA, USA aut Morita Eugene Department of Nuclear Medicine, University of California, San Francisco, CA, USA aut Treseler Patrick Department of Pathology, University of California, San Francisco, CA, USA aut Huang Laura Department of Surgery, University of California, San Francisco, CA, USA aut Thummala Suresh Department of Dermatology, University of California, San Francisco, CA, USA aut Allen Robert Department of Surgery, University of California, San Francisco, CA, USA aut Kashani-Sabet Mohammed Department of Dermatology, University of California, San Francisco, CA, USA aut Leong Stanley Department of Surgery, University of California, San Francisco, CA, USA aut Annals of Surgical Oncology Springer-Verlag 18/10(2011-10-01), 2919-2924 1068-9265 18:10<2919 2011 18 10434 https://doi.org/10.1245/s10434-011-1689-0 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1245/s10434-011-1689-0 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Liu Liang-Chih Department of Surgery, University of California, San Francisco, CA, USA aut NATIONALLICENCE 700 1- Parrett Brian The Buncke Clinic, Division of Plastic Surgery, California Pacific Medical Center, San Francisco, CA, USA aut NATIONALLICENCE 700 1- Jenkins Tyler Department of Surgery, University of California, San Francisco, CA, USA aut NATIONALLICENCE 700 1- Lee Wayne Department of Surgery, University of California, San Francisco, CA, USA aut NATIONALLICENCE 700 1- Morita Eugene Department of Nuclear Medicine, University of California, San Francisco, CA, USA aut NATIONALLICENCE 700 1- Treseler Patrick Department of Pathology, University of California, San Francisco, CA, USA aut NATIONALLICENCE 700 1- Huang Laura Department of Surgery, University of California, San Francisco, CA, USA aut NATIONALLICENCE 700 1- Thummala Suresh Department of Dermatology, University of California, San Francisco, CA, USA aut NATIONALLICENCE 700 1- Allen Robert Department of Surgery, University of California, San Francisco, CA, USA aut NATIONALLICENCE 700 1- Kashani-Sabet Mohammed Department of Dermatology, University of California, San Francisco, CA, USA aut NATIONALLICENCE 700 1- Leong Stanley Department of Surgery, University of California, San Francisco, CA, USA aut NATIONALLICENCE 773 0- Annals of Surgical Oncology Springer-Verlag 18/10(2011-10-01), 2919-2924 1068-9265 18:10<2919 2011 18 10434 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer